What you need to know about childhood asthma
Does your child have asthma? Here's what all parents should know
If your child has been diagnosed with asthma, you know it can be a struggle to manage, and at times a scary health concern for everyone involved. But what is asthma, how does a child get it, what are the triggers and what are the symptoms and treatment options?
According to Susan A. Schaefer, MD, Dartmouth-Hitchcock Specialty Care at Bedford Medical Park — whose institution affiliations include CHaD allergy and pediatric allergy — asthma is defined as a common, chronic disorder of the airways that is characterized by variable and recurring symptoms, airflow obstruction, bronchial hyper-responsiveness, and an underlying inflammation of the lungs. Typical symptoms include episodic shortness of breath, chest tightness, wheezing and cough.
William Siroty, MD, of Nashua Medical Group/St. Joseph Hospital, a board-certified internal medicine physician, allergist and immunologist, said asthma is often thought to be due to exposure to allergens such has pollens, dust mites, molds and animal dander, which causes the inflammation due to specific antibodies the body produces. In some children, Dr. Siroty said, exercise can also cause asthma. Schaefer adds that other common triggers for asthma include respiratory infections, allergies, irritants such as cigarette smoke, and weather changes.
The inflammation that leads to asthma, Siroty said, causes the airways in the lung to become swollen and causes tightening of the muscles in around the airways, making it difficult for air to move in and out. In children and infants this causes symptoms such as wheezing, coughing, rapid or difficulty breathing, chest pains, decreased energy and feeling tired. Risk factors for developing childhood asthma include allergies, a family history of allergies or asthma, frequent respiratory symptoms, low birth weight, exposure to second-hand smoke, and smoking during pregnancy and shortly thereafter.
Like many other environmentally related health issues, such as certain allergies, asthma appears to be on the rise both in New Hampshire and across the United States.
“Childhood asthma has increased over time; like the increase in food allergies, the reasons for this increase are unknown,” says Dr. Siroty, who adds that 25,000 children had asthma in 2008 and estimates that number in New Hampshire is now anywhere from 26,000 to 28,000.
“Two theories as to why this is occurring include global warming, which is increasing the amount of pollen in the air and thus increases the incidence of asthma, and air pollution is also believed to increase inflammation in the lungs.”
Dr. Robert Hickey, of Allergy Associates of New Hampshire, shares a more recent statistic: Center for Disease Control data from 2011, Hickey says, reports 7.1 million children in the United States with asthma, which equates to 9.5 percent.
Schaefer also adds that an estimated 8 percent to 12 percent of children in New Hampshire have been given a diagnosis of asthma at some point, which is on par with asthma statistics for the United States.
“It is not clear why we are seeing a rise in asthma and other atopic disorders, such as allergic rhinitis and food allergies, in the United States and other westernized countries,” she says. “The ‘Hygiene Hypothesis’ is a popular theory that attributes a rise in allergic disorders to a decrease in childhood infections due to immunizations, use of antibiotics and improved hygiene, such as clean water and non-crowded living conditions.”
Treatment options include medication such as Albuterol, which relaxes the muscles in the airways to make it easier to breathe; inhaled steroids, which are anti-inflammatory; Montelukast, which is also anti-inflammatory; allergy immunotherapy (allergy shots), and environmental controls. Schaefer points out that treatment options vary depending on the severity of an individual’s asthma — some patients require only intermittent treatment, however, many patients need daily anti-inflammatory medications in addition to as-needed (“rescue”) treatment.
Controlling exacerbating factors such as allergies is also important for patients with asthma.
“All children with asthma should also receive a yearly influenza vaccine, as influenza can significantly exacerbate asthma,” Hickey said.
Allergy immunotherapy, Siroty said, is given based on results of either skin tests or blood tests and involves the injection of small amounts of the offending allergen, which are gradually increased over time. Injections are initially given weekly and then every two to four weeks. This treatment option can be highly effective in relieving both allergic asthma and allergic rhinitis (hay fever) symptoms.
New experimental treatments include giving the allergens under the tongue or in a pill form, however it is unclear if and when these treatment options will be approved in this country. Environmental controls involve removal of the offending allergen if possible, such as pets, dust mites and molds.
“CDC and National Health Survey data has shown an increasing trend of asthma over the previous 20 years with a greater increase in children than adults,” Hickey said. “This mirrors a similar increase in all allergic diseases – asthma, food allergy, atopic dermatitis/eczema, and allergic rhino-conjunctivitis. The leading theory is the hygiene hypothesis.”
If current trends continue, childhood asthma will continue to be on the rise so it’s important for parents to understand what it is, and what options you have if your child has it, so that you can all breathe easier.
Julia K. Agresto works full-time as a writer at Rivier University in Nashua, as well as freelancing as a writer for various publications and volunteering as a public relations coordinator for a charity group in Connecticut. She lives in Nashua.